Wright Test, also called the Hyperabduction Test, assesses whether shoulder hyperabduction reproduces familiar upper-limb symptoms or vascular-type changes. It is commonly used in thoracic outlet assessment, particularly when symptoms may relate to the pectoralis minor or retropectoralis region. Current thoracic outlet literature emphasises that TOS diagnosis is challenging and should not rely on a single provocative test.
A client reports arm heaviness, tingling, fatigue or colour change when reaching overhead or holding the arm elevated. The symptoms may appear during throwing, swimming, work overhead or prolonged arm positioning.
Wright Test can help document whether hyperabduction reproduces familiar symptoms. However, it should not be used alone to diagnose thoracic outlet syndrome, because provocative tests can produce symptoms in people without TOS and because TOS presentations vary.
Test name: Wright Test
Also known as: Hyperabduction Test
Body region: Thoracic outlet, shoulder girdle, pectoralis minor region and upper limb
Purpose: Assess symptom response to shoulder hyperabduction
Positive finding: Familiar upper-limb symptoms, vascular-type symptoms or marked pulse change with symptoms
Negative finding: No familiar symptom reproduction and no concerning vascular response
Best used with: History, vascular screen, neurological screen, Adson’s, Eden, Halstead, Roos/EAST, cervical assessment and shoulder assessment
Key limitation: It does not diagnose thoracic outlet syndrome on its own
Wright Test is a thoracic outlet provocation test where the client’s arm is moved into abduction or hyperabduction, often with external rotation. The professional monitors symptoms and may monitor the radial pulse.
The test is commonly described as stressing the neurovascular structures around the pectoralis minor or retropectoralis minor space, but it does not isolate one structure.
Wright Test is used when symptoms appear to be provoked by overhead or abducted arm positions.
It may help assess symptom response to positions used in overhead work, sport, reaching and sustained arm elevation.
The test assesses symptom response to hyperabduction loading. It may involve neural, vascular, muscular, shoulder or cervical contributors.
It does not confirm neurogenic, arterial or venous thoracic outlet syndrome.
This test may be useful for clients with arm heaviness, tingling, numbness, hand fatigue, overhead symptoms, shoulder girdle symptoms or vascular-type symptoms that occur with arm elevation.
Use when thoracic outlet or overhead positional symptoms are part of the clinical reasoning and the arm can be elevated safely.
Use caution with unexplained arm swelling, colour change, coldness, suspected clotting, known vascular disease, dizziness, severe neurological symptoms, acute shoulder injury, severe shoulder pain or symptoms suggesting urgent medical review.
Chair or standing space
Pain and symptom scale
Pulse monitoring if used
Measurz recording workflow
Optional vascular and neurological screen notes
Position the client sitting or standing upright.
The arm starts relaxed by the side.
Stand beside the tested arm.
One hand may guide the arm into abduction or hyperabduction. The other may monitor the radial pulse if used.
Avoid forcing the shoulder. Keep the trunk and neck position recorded.
Move the arm into abduction or hyperabduction, with external rotation depending on the selected method.
Ask the client to report tingling, numbness, heaviness, pain, fatigue, coldness, colour change, dizziness or familiar symptoms.
A positive finding is reproduction of familiar upper-limb symptoms, vascular-type symptoms or a marked pulse change with symptoms.
A negative finding is no familiar symptom reproduction and no concerning vascular response.
Stop if symptoms increase sharply, vascular signs appear, dizziness occurs, neurological symptoms worsen, shoulder pain becomes limiting or the client feels unwell.
Do not interpret pulse change alone as diagnostic. Record symptoms, timing and arm angle.
A positive Wright Test may support suspicion that hyperabduction or pectoralis minor region loading contributes to symptoms. It does not confirm TOS.
A negative test does not exclude TOS, especially if symptoms occur with other positions or longer exposure.
Interpretation is stronger when paired with history, vascular screen, neurological screen, cervical assessment, shoulder assessment, upper-limb neurodynamic testing and other thoracic outlet tests.
High-quality 2020+ diagnostic accuracy values for Wright Test alone were not identified. Current thoracic outlet reviews describe TOS as a rare and heterogeneous condition with symptoms such as arm pain, swelling, fatigue, paraesthesia, weakness and hand discoloration, and classify it as neurogenic, arterial or venous depending on the compressed structure.
A 2022 study of a standardised elevated arm stress test found low discriminative value for neurogenic TOS diagnosis, reinforcing the need for caution when interpreting thoracic outlet provocation tests in isolation.
Reliability depends on arm angle, shoulder rotation, pulse monitoring, symptom criteria, test duration and examiner technique.
Because Wright Test protocols vary, repeatability improves when the exact arm angle, neck position, duration and symptom response are recorded.
Common errors include forcing hyperabduction, using pulse change alone as positive, ignoring shoulder pain, failing to record arm angle, not documenting symptom timing and diagnosing TOS from one test.
Limitations include false positives, non-specific symptoms, shoulder mobility influence, cervical contribution, variable protocol and limited stand-alone diagnostic evidence.
Use Wright Test to document symptom response to overhead or hyperabducted arm positioning. It may be useful for comparing symptom onset between sides and tracking tolerance over time.
Record test name, side tested, result, pain score, symptom location, symptom quality, arm angle, shoulder rotation, neck position, duration, pulse response if monitored, vascular symptoms, neurological symptoms, dizziness, comparison side, confidence in result and reason for stopping.
Add related findings such as Adson’s, Eden, Halstead, Roos/EAST, cervical ROM, shoulder ROM, grip strength, neurodynamic testing and vascular screen notes.
Adson’s Test
Eden Test
Halstead Test
Roos Stress Test
Upper Limb Tension Test
Cervical ROM Tests
Shoulder ROM Tests
Grip Strength Test
It assesses whether shoulder hyperabduction reproduces familiar upper-limb or vascular-type symptoms.
A positive finding is familiar symptom reproduction or vascular-type symptoms. Pulse change alone is not enough.
No. It may support clinical reasoning but does not diagnose TOS on its own.
Stop for dizziness, colour change, marked symptom increase, vascular symptoms, neurological worsening or severe shoulder pain.
Record side, arm angle, symptoms, pulse response if monitored, duration and reason for stopping.
Wright Test is a hyperabduction thoracic outlet provocation test.
It should reproduce familiar symptoms to be meaningful.
Pulse change alone is not diagnostic.
TOS assessment requires broader clinical context.
Measurz should capture arm angle, symptoms, pulse response and stopping reason.
Masocatto, N. O., Da-Matta, T., Prozzo, T. G., Couto, W. J., & Porfirio, G. (2022). Thoracic outlet syndrome: A narrative review. Frontiers in Cardiovascular Medicine, 9, 802183.
Pesser, N., de Bruijn, B. I., Goeteyn, J., Verhofstad, N., Houterman, S., van Sambeek, M. R. H. M., Thompson, R. W., van Nuenen, B. F. L., & Teijink, J. A. W. (2022). Reliability and validity of the standardized elevated arm stress test in the diagnosis of neurogenic thoracic outlet syndrome. Journal of Vascular Surgery, 76(3), 821–829.e1.
